4.4 Article

Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI

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BRITISH JOURNAL OF RADIOLOGY
卷 84, 期 999, 页码 271-278

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BRITISH INST RADIOLOGY
DOI: 10.1259/bjr/10315979

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Objectives: Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T-1 and T-2 weighted MRI was compared. Methods: 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T1 contrast-enhanced (T1(PRE)CTV and T1(POST)CTV) and T-2 weighted images (T2(PRE)CTV and T2(POST)CTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (Cl) was defined as the ratio between the overlapping and composite volumes. Results: The volumes of T1(PRE)CTV and T1(POST)CTV were not statistically different (248 +/- 88 vs 254 +/- 101), although volume differences >100 cm(3) were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T-2 volumes (139 +/- 68 vs 78 +/- 59). Lack of concordance was observed between T1(PRE)CTV and T1(POST)CTV (CI=0.67 +/- 0.09), T2(PRE)CTV and T2(POST)CTV (CI=0.39 +/- 0.20) and comparing the portion of the T1(PRE)CTV and T1(POST)CTV not covered by that defined on T2(PRE)CTV images (CI=0.45 +/- 0.16 and 0.44 +/- 0.17, respectively). Conclusion: Using T-2 MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T-1 MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T-1 weighted MRI for planning purposes.

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